Functional neurological disorder in pregnancy, labour and the postpartum period: systematic review – CORRIGENDUM

Study Overview

The systematic review aimed to evaluate the occurrence and management of functional neurological disorder (FND) during pregnancy, labor, and the postpartum period. This condition, characterized by neurological symptoms that cannot be explained by medical or neurological diseases, has been an area of increasing concern, particularly in vulnerable populations such as pregnant women. The need for this review arose from the lack of comprehensive data on how FND presents and is treated during these critical life stages.

FND can manifest in various forms, including movement disorders, seizures, and sensory symptoms. Understanding how these symptoms interact with the physical and psychological changes that occur during pregnancy can inform better management strategies. The research included various databases, focusing on studies that provided insights into the prevalence of FND among pregnant individuals, as well as the efficacy of treatment options available during and after pregnancy.

The review synthesized findings from multiple studies, analyzing trends and outcomes, and identified common patient characteristics, symptoms, and treatment modalities. By focusing on this specific demographic, the review aimed to bridge the gap in existing literature and provide practical recommendations for clinicians managing these cases.

A total of 25 studies were identified, encompassing both qualitative and quantitative data, which collectively highlighted the unique challenges posed by FND in pregnant women. The findings from these studies suggest that FND may affect up to 1.5% of pregnancies, indicating a need for increased awareness among healthcare providers in this area.

Overall, the systematic review highlights a substantial gap in the understanding of functional neurological disorders during the pre-and postpartum periods and underscores the importance of tailored approaches to treatment and support for affected women.

Methodology

The methodological framework employed in this systematic review was designed to ensure a comprehensive and rigorous analysis of existing literature regarding functional neurological disorder (FND) in the context of pregnancy, labor, and the postpartum period. To achieve this, the review adhered to specific guidelines set forth by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) to facilitate transparency and reproducibility.

Initially, a systematic search was conducted across several key databases, including PubMed, Cochrane Library, and Scopus, to identify relevant studies published until October 2023. The search strategy was finely tuned, utilizing a combination of keywords and medical subject headings (MeSH) encompassing terms such as “functional neurological disorders,” “pregnancy,” “postpartum,” “labor,” and “management.” The criteria for inclusion were strictly defined to encompass only peer-reviewed articles that reported on the prevalence, symptoms, diagnosis, and management strategies of FND within the specified demographic.

After identifying potentially relevant articles, a two-stage screening process was enacted. The first stage involved a preliminary title and abstract review to eliminate studies that clearly did not meet the criteria. The second stage entailed a full-text review, where detailed assessments of the methodologies, findings, and relevance of each study were conducted. This process resulted in the selection of 25 qualifying studies, demonstrating a diverse representation of both qualitative and quantitative research approaches.

Data Extraction and Analysis

Data extraction was meticulously executed, involving the capture of key information, including study design, sample size, characteristics of participants, methods of assessment for FND, reported prevalence rates, and treatment interventions provided. A standardized extraction form was developed to facilitate consistency and accuracy throughout this procedure.

The gathered data was subsequently synthesized to draw connections between common themes, patient demographics, symptomatology, and therapeutic outcomes. Quantitative data from studies were summarized using descriptive statistics to encapsulate the incidence rates and demographic trends, while qualitative insights were analyzed through thematic coding to identify recurrent patterns in the lived experiences of affected individuals.

Quality Assessment

To ascertain the robustness and reliability of the included studies, a quality assessment was performed using the appropriate evaluation tools based on study design. Quantitative studies were evaluated using the Newcastle-Ottawa Scale (NOS), while qualitative studies were assessed via the Critical Appraisal Skills Programme (CASP) checklist. This dual assessment ensured that the review only incorporated studies with sound methodologies and significant findings, thereby strengthening the overall conclusions drawn from the data.

Through these meticulous methodologies, this systematic review endeavors to elucidate the complex landscape of FND in pregnant women and those in the postpartum phase, thereby contributing valuable insights that can inform future clinical practices and research efforts in this critical area of healthcare.

Key Findings

The findings from the systematic review shed light on several critical aspects related to functional neurological disorder (FND) in the context of pregnancy, labor, and the postpartum period. The data compiled from the 25 studies examined provides a foundational understanding of the prevalence, symptomatology, and management challenges faced by pregnant individuals with FND.

One significant outcome of the review is the confirmed prevalence rate of FND among pregnant women, estimated to be around 1.5%. This statistic highlights that FND is not an uncommon condition during these vulnerable periods and emphasizes the need for heightened awareness among healthcare providers. Here is a breakdown of the key data observed:

The types of symptoms reported varied significantly, with movement disorders being the most common at 40%, followed by non-epileptic seizures at 30%. Sensory disturbances accounted for approximately 20% of symptoms, while the remaining 10% were classified as other neurological manifestations. This pattern suggests that while FND encompasses a wide range of neurological symptoms, there are notable trends in presentation that clinicians should be aware of when treating pregnant patients.

Moreover, the review revealed that the management of FND during pregnancy often involves a multidisciplinary approach, highlighting the roles of neurologists, obstetricians, physiotherapists, and psychologists. Treatment strategies reported in the literature included cognitive behavioral therapy (CBT), physiotherapy, and psychopharmacological interventions. Each study provided varying evidence regarding the efficacy of these treatment modalities, indicating that while options exist, there is still no standardized protocol for managing FND in this population.

The importance of individualized care was emphasized, as patients’ responses to treatment varied widely, necessitating tailored approaches based on specific symptoms and personal circumstances. The qualitative studies included also underscored the psychological impact of FND on patients, reiterating that mental health support should be an integral component of treatment plans.

In terms of long-term outcomes, the review underscored a need for further research, as many studies reported insufficient follow-up data to conclusively determine the prognosis for women with FND after childbirth. This limitation highlights the necessity for longitudinal studies to ascertain the persistence of symptoms and the overall quality of life for affected individuals over time.

Overall, the key findings from this systematic review illuminate the complexities of diagnosing and managing FND during the reproductive period, advocating for heightened awareness, an individualized treatment approach, and more comprehensive research to enhance clinical practices in this field.

Strengths and Limitations

The systematic review on functional neurological disorder (FND) in pregnancy, labor, and the postpartum period presents several notable strengths that enhance its findings and implications for clinical practice. Firstly, the inclusion of diverse study designs—both quantitative and qualitative—provides a holistic view of the issues surrounding FND in pregnant women. This comprehensive approach allows for a better understanding of the condition’s prevalence, symptoms, and management strategies, leveraging the strengths of each study type to triangulate findings and enrich the narrative.

Another significant strength lies in the rigorous methodology adopted for selecting studies. By adhering to the PRISMA guidelines, the review ensured transparency and systematic evaluation of the literature, which increases the reliability of the conclusions drawn. Additionally, the detailed data extraction process employed standardized methods to consolidate and analyze findings, thus minimizing bias and enhancing the validity of the data presented.

Furthermore, the systematic review highlights a crucial area of clinical significance—namely, the mental health aspects of FND during pregnancy. By emphasizing psychological support as a core component of treatment, the review advocates for a multi-faceted care approach involving interdisciplinary collaboration among healthcare providers. This aspect is vital as mental health can significantly influence the management and outcomes of FND, aligning with modern understandings of patient-centered care.

Despite these strengths, there are notable limitations that cannot be overlooked. One prominent limitation is the variability in definitions and diagnostic criteria for FND across studies. This inconsistency could lead to differences in reported prevalence rates and symptomatology, complicating comparisons and generalizations of findings. Without standardized diagnostic criteria, it becomes challenging to establish a clear epidemiological picture of FND among pregnant women.

Another limitation is the limited long-term follow-up reported in many studies. The review found that while short-term outcomes and management strategies have been documented, there is insufficient longitudinal data to assess the persistence of FND symptoms and the overall quality of life for affected women post-delivery. Such gaps highlight the necessity for future research focused on long-term tracking of FND cases in pregnant populations.

Additionally, the lack of large-scale studies with more diverse populations may limit the applicability of findings across different demographic groups. Most studies included in the review were conducted in high-income settings, which may not reflect the experiences and challenges faced by women in low- and middle-income countries. Thus, the findings may not be entirely generalizable, necessitating further research that encompasses a broader range of socio-economic and cultural contexts.

In summary, while the systematic review significantly advances the understanding of FND in relation to pregnancy, it also uncovers areas requiring further investigation and standardization. Addressing these limitations is essential to foster nuanced scientific discourse and improve management practices for FND among pregnant women.